Most preventive efforts nationally have been devoted to risk factor modification in the asymptomatic population (primary prevention)1,2 or intervention in individuals who have sustained cardiovascular morbid events (secondary prevention)3-6. Little attention has been directed to the early recognition of cardiovascular disease before organ involvement has occurred. Risk factor modification is aimed at preventing progression of disease but can have no benefit in individuals who do not have vascular or cardiac disease and are not at risk for a premature cardiovascular event. Furthermore, cardiovascular disease often exists and progresses in the absence of the traditional risk markers and its course can still be altered by intervention. Focusing on risk factor identification and management alone is doomed to insensitivity and non-specificity in achieving risk reduction, whereas focusing on individuals with advanced disease will not accomplish the desired goal of symptomatic disease prevention and health care cost reduction.
Risk markers such as age, blood pressure, cholesterol levels, blood sugar, homocysteine and inflammatory markers may correlate with the risk of cardiovascular events7-10, much as the barometer may predict the likelihood of rain, but the first few raindrops are a far more sensitive and specific marker for raising the umbrella. Since potent interventions are now available to slow the progression of cardiovascular the need has increased for techniques that can identify the earliest markers for the disease rather than the risk. Such data might allow the application of a much more targeted approach to the prevention of first events in asymptomatic individuals.
A community testing and screening center was used to screen ostensibly healthy individuals in the Twin Cities community for detection of early markers for vascular and cardiac disease. A comprehensive array of non-invasive testing was developed using techniques that have either been established or advocated for early detection. In addition we undertook measurement of modifiable risk contributors that could serve to steer interventions in those with markers for disease.